Neoadjuvant chemoradiotherapy for rectal cancer: How important is tumour regression?

M. J. McCoy, C. Hemmings, S. Hillery, C. Penter, M. K. Bulsara, N. Zeps, C. F. Platell

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    10 Citations (Scopus)

    Abstract

    BACKGROUND: Pathological complete response following neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer is associated with reduced local recurrence and improved long-term outcome. However, the prognostic value of a partial response, or of tumour regression in patients with metastatic disease, is less clear. METHODS: We present a single-centre cohort study of 205 patients with stage II-IV rectal cancer treated with surgery and neoadjuvant CRT between 2006 and 2013. Tumour regression was assessed using the Dworak system. RESULTS: The probability of 3-year recurrence-free survival (RFS) was 95% for Dworak grade 4, 82% for grade 3, 64% for grade 2 and 53% for grade 1 (P = 0.0005). In univariate regression analysis, Dworak grade was associated with RFS (hazard ratio (HR) 0.51, P <0.0001; trend analysis) and cancer-specific survival (HR 0.52, P = 0.002). In multivariate analysis, Dworak grade remained an independent predictor of RFS (HR 0.62, P = 0.012), along with clinical metastases stage, resection margin status, the presence or absence of extramural venous invasion and type of surgical procedure. CONCLUSIONS: Tumour regression grade after neoadjuvant CRT was an independent prognostic factor for RFS, highlighting the importance of the degree of local response to CRT.
    Original languageEnglish
    Pages (from-to)E233-E239
    Number of pages7
    JournalANZ Journal of Surgery
    Volume87
    Issue number12
    Early online date3 Dec 2015
    DOIs
    Publication statusPublished - Dec 2017

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